There are difficulties sometimes associated with the closure of the trocar wound site for example, in laparoscopic procedures. There are difficulties in particular in finding the fascia layer through which a suture must be passed to ensure good and adequate port site closure.
With deeper port sites, such as with an obese patient, it is often more difficult for the surgeon to gain deep access to the fascial layer to securely place a suture therein. In certain instances it may be necessary to cut open the wound to accurately place a suture fixation on the inner fascia layer.
The consequences of inadequate closure may be serious. For example, the patient may be subject to an early or late onset hernia, bowel stricture and/or bleeding from the port site. All of these complications have varying associated morbidities up to and including fatalities in serious undetected bowel strictures. The rate of port site herniation is widely published to be up to 3% for the normal population and double this for the obese cohort.
There are therefore a number of problems with current methods of trocar port site closure that need to be addressed, particularly for the obese patient.
There are further difficulties in anchoring or otherwise securing laparoscopic surgical devices relative to a laparoscopic surgical port, in particular with Hasson type ports. Suture stays can be difficult to manage during Hasson trocar sleeve or olive fixation and can become tangled when removing or adjusting the trocar. These problems also need to be addressed in order to ensure an efficient workflow for the surgeon.
Typically an olive or trocar sleeve is provided for a specific trocar type (Hasson) and the two are provided in co-operation with one another prior to any surgical insertion of the trocar into the abdominal wall. This is not always appropriate as not all surgery requires use of an olive at the start of the procedure, particularly off midline when utilizing radially dilating trocars. However, with excessive trocar manipulation, improved trocar anchoring and subsequent port closure may be required.